Provider Demographics
NPI:1528400702
Name:DELTA MEDICAL TRANSPORT, INC.
Entity Type:Organization
Organization Name:DELTA MEDICAL TRANSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELAGIB
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELBASHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-755-7774
Mailing Address - Street 1:PO BOX 28723
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-8723
Mailing Address - Country:US
Mailing Address - Phone:804-755-7774
Mailing Address - Fax:804-755-7774
Practice Address - Street 1:8305 WILLOW RIDGE PL
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3296
Practice Address - Country:US
Practice Address - Phone:804-755-7774
Practice Address - Fax:804-755-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport